<link href="<?php echo $this->config->item('webroot');?>/css/register.css" rel="stylesheet" />
<div class="register">
	<h3>Đăng ký tài khoản giao dịch</h3>
	<p>(Vui lòng nhập đầy đủ các thông tin có dấu *)</p>
	<div>
		<form>
			<table cellpadding="5">
				<tr>
					<th colspan="4">Thông tin tài khoản Fiwin</th>
				</tr>
				<tr>
					<td width="40px;"></td>
					<td>Email*</td>
					<td><input type="text" name="Email" value="<?php echo @$Email;?>" class="text"></td>
					<td></td>
				</tr>
				<tr>
					<td></td>
					<td>Mật khẩu*</td>
					<td><input type="password" name="Password" class="text"></td>
					<td></td>
				</tr>
				<tr>
					<td></td>
					<td>Kiểm tra mật khẩu*</td>
					<td><input type="password" name="Password" class="text"></td>
					<td></td>
				</tr>
				<tr>
					<th colspan="4">Thông tin cá nhân</th>
				</tr>
				<tr>
					<td></td>
					<td>Họ và tên*</td>
					<td><input type="text" name="Name" value="<?php echo @$Name;?>" class="text"></td>
					<td></td>
				</tr>
				<tr>
					<td></td>
					<td>Giới tính*</td>
					<td>
						<select name="Gender">
							<option value="0">Chọn giới tính</option>
							<option value="1">Nam</option>
							<option value="2">Nữ</option>
						</select>
					</td>
					<td></td>
				</tr>
				<tr>
					<td></td>
					<td>Số CMND / Hộ chiếu*</td>
					<td><input type="text" name="Passport" value="<?php echo @$Passport;?>" class="text"></td>
					<td></td>
				</tr>
				<tr>
					<td></td>
					<td>Quốc gia*</td>
					<td>
						<select name="Country">
							<option value="0">Chọn quốc gia</option>
							<?php if(!empty($ListCountry)) :?>
								<?php foreach($ListCountry as $Item) :?>
									<option value="<?php echo $Item->CountryID?>" <?php if($Country == $Item->CountryID) echo 'selected';?>><?php echo $Item->CountryName?></option>
								<?php endforeach;?>
							<?php endif;?>
						</select>
					</td>
					<td></td>
				</tr>
				<tr>
					<td></td>
					<td>Số điện thoại*</td>
					<td><input type="text" name="PhoneNumber" value="<?php echo @$PhoneNumber;?>" class="text"></td>
					<td></td>
				</tr>
				<tr>
					<td></td>
					<td>Ngày sinh*</td>
					<td><input type="text" name="BirthDay" value="<?php echo @$BirthDay;?>" class="text"></td>
					<td></td>
				</tr>
				<tr>
					<th colspan="4">Thiết lập tài khoản giao dịch</th>
				</tr>
				<tr>
					<td></td>
					<td>Đòn bẩy*</td>
					<td>
						<select name="Leverage">
							<option value="1" <?php if(@$Leverage == 1) echo 'selected';?>>1:200</option>
							<option value="2" <?php if(@$Leverage == 2) echo 'selected';?>>1:100</option>
							<option value="3" <?php if(@$Leverage == 3) echo 'selected';?>>1:50</option>
						</select>
					</td>
					<td></td>
				</tr>
				<tr>
					<th colspan="4">Địa chỉ liên lạc</th>
				</tr>
				<tr>
					<td></td>
					<td>Địa chỉ liên lạc*</td>
					<td><input type="text" name="Address" value="<?php echo @$Address;?>" class="text"></td>
					<td></td>
				</tr>
				<tr>
					<td></td>
					<td>Quận / Huyện*</td>
					<td><input type="text" name="District" value="<?php echo @$District;?>" class="text"></td>
					<td></td>
				</tr>
				<tr>
					<td></td>
					<td>Tỉnh / Thành phố*</td>
					<td><input type="text" name="City" value="<?php echo @$City;?>" class="text"></td>
					<td></td>
				</tr>
				<tr>
					<td></td>
					<td>Mã bưu chính*</td>
					<td><input type="text" name="ZipCode" value="<?php echo @$ZipCode;?>" class="text"></td>
					<td></td>
				</tr>
				<tr>
					<th colspan="4">Thông tin Ngân hàng</th>
				</tr>
				<tr>
					<td></td>
					<td>Họ và tên*</td>
					<td><input type="text" name="BankUser" value="<?php echo @$BankUser;?>" class="text"></td>
					<td></td>
				</tr>
				<tr>
					<td></td>
					<td>Tên ngân hàng*</td>
					<td>
						<select name="BankName">
							<option value="0">Chọn ngân hàng</option>
							<?php if(!empty($ListBank)) :?>
								<?php foreach($ListBank as $Item) :?>
									<option value="<?php echo $Item->BankID;?>" <?php if($BankName == $Item->BankID) echo 'selected';?>><?php echo $Item->BankName?></option>
								<?php endforeach;?>
							<?php endif;?>
						</select>
					</td>
					<td></td>
				</tr>
				<tr>
					<td></td>
					<td>Số tài khoản*</td>
					<td><input type="text" name="BankCode" value="<?php echo @$BankCode?>" class="text"></td>
					<td></td>
				</tr>
				<tr>
					<th colspan="4">Thông tin tài chính</th>
				</tr>
				<tr>
					<td></td>
					<td>Thu nhập ước tính của bạn*</td>
					<td>
						<select name="Income">
							<option value="0">Chọn</option>
							<option value="1">&lt; 10,000</option>
							<option value="2">10,000 - 50,000</option>
							<option value="3">50,000 - 100,000</option>
							<option value="4">&gt 100,000</option>
						</select>
					</td>
					<td></td>
				</tr>
				<tr>
					<td></td>
					<td>Thu nhập trung bình hàng năm*</td>
					<td>
						<select name="AnnualIncome">
							<option value="0">Chọn</option>
							<option value="1">&lt; 10,000</option>
							<option value="2">10,000 - 50,000</option>
							<option value="3">50,000 - 100,000</option>
							<option value="4">&gt 100,000</option>
						</select>
					</td>
					<td></td>
				</tr>
				<tr>
					<td></td>
					<td>Nghề nghiệp*</td>
					<td><input type="text" name="Industry" class="text"></td>
					<td></td>
				</tr>
			</table>
		</form>
	</div>
</div>